| NPI | 1306395058 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NURAH JAHAN ABDUR-RAHMAN Credentialing Coordiantor 718-636-4500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 058667) |
| Enumeration Date | 2016-09-22 |
| Last Update Date | 2016-09-22 |